Racial, ethnic differences in outcomes of extremely preterm infants decreasing but persistent

1. In this retrospective cohort study reviewing data from 2006 to 2017, researchers showed very premature infants identified as African American had more rapid declines in infant mortality, hypothermia, necrotizing enterocolitis (NEC),and length of stay as compared to white infants, while infants identified as Hispanic had more rapid declines in respiratory distress syndrome (RDS), pneumothorax as compared to very premature white infants.

2. Despite these declines, mortality and severe morbidity remained elevated overall compared to white infants, particularly for African American newborns.

Evidence Rating Level: 2 (Good)     

Study Rundown: Though extreme prematurity is a major contributor to infant mortality, advances in in-hospital care of these newborns have improved outcomes in recent years. Still, little is known about how such advances have shifted outcomes among different racial and ethnic groups. In this study, researched examined the rates at which various obstetric and neonatal interventions were implemented in different racial and ethnic groups as well as the subsequent outcomes for each of these populations over an 11-year period. Through use of data from the Vermont Oxford Network (VON), researchers discovered that, in comparison to white infants, African American infants had a more rapid decline in mortality, hypothermia, NEC, and length of stay (LOS) and Hispanic infants had a faster decline in mortality, RDS, and pneumothorax, over the course of the study period. Despite these steeper rates of decline, mortality and several areas of severe morbidity remained relatively elevated for African American and Hispanic infants as compared to white infants at the end of the study period. As noted by the authors, the declines in various outcomes noted in this study offer areas for further intervention, though the persistent gap in outcomes warrants its own distinct investigation into other factors which may be at play.

Click here to read the original article in Pediatrics

Relevant Reading: Impact of Race and Ethnicity on the Outcome of Preterm Infants Below 32 Weeks Gestation

In-Depth [retrospective cohort]: In this study, researchers used data from VON to evaluate outcome disparities in over 215 000 infants born across the United States and Puerto Rico born at 22 to 29 weeks’ gestation between 2006 and 2017 (40.6% white, 34.8% African American, 20.4% Hispanic, 4.2% Asian American). Researchers discovered that the overall rates of mortality, hypothermia, NEC, and LOS remained higher for African American infants as compared to white infants over the study period, though the rate in decline of these outcomes was more rapid for African American infants as compared to white infants during the same study period (mortality: p < .0001; hypothermia: p < .0001; NEC: p = .028; LOS: p < .0001). Despite the more rapid decline, the overall rate of mortality, hypothermia, NEC, and longer LOS were all still elevated for African American infants at the end of the study period as compared to white infants. Similarly, for Hispanic infants as compared to white infants, Hispanic infants experienced a faster rate of decline in mortality (p = .032), RDS (p < .001), and pneumothorax (p = .0016) over the study period. Unlike African American infants, mortality among Hispanic infants was only slightly higher for some but not all years of the study, while rates of RDS and pneumothorax were slightly lower for some but not all years of the study.

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